paedriactric trauma Flashcards
What is osetogenesis imperfecta?
When are fractures most likely? (not in relation to the above)
Where are the most common fractures?
“Brittle bone syndrome” -> due to genetic mutations in the formation of collagen.
In summer time, and of the forearm.
Why do kids fractures heal quickly?
Because their bones are growing, they have a super thick layer of periosteum which can supply with nutrients etc and they have a great blood supply.
What are the 4 types of fractures in childresn?
-Greenstick -> how a greenstick fractures (not all the way across)
-Buckle (torus) -> compressed
-Plastic deformity (rare case of buckle) -> bends under pressure - can dislocate
-Physeal fractures -> classification SALTC:
-Straight across
-across then Above
-“” beLow
-Through
-Compressed cortex
-Avulsions - particularly due to the ligaments being stronger than the bones
buckle fracture treatment?
short splintage as they are pretty stable
What percent are operated on?
5%
What are the options for operative fixation?
Internal (main stay, cna be nail or plate), external (monolateral or circular)
How do childrens+’s fractures re-model, and whre eis this best?
Appositional periosteal growth/resorption
Differential physeal growth
More in metaphyseal region, more in younger.
Translation is better than angulation is better than rotational injuries for becomming better
Where are the better and worse places to remodel?
More in metaphyseal region, more in younger.
Translation is better than angulation is better than rotational injuries for becomming better
how do we stop shortening of th femur in femoral fractures?
SPlint it!! traction splint -> mid shaft femur fractures.
How do we rteat childrens fractures?
-Reduce the fracture (if needed)
-Immobilise
-Remove cast/splint when healed
Joint stiffness rare
Open fractures debride
:eriosteal hinge, what does that mean and why is it importnat?
Its if you have eg greestick fracture, the periosteum can still be attached and it can stop the fracture from easily being able to be reduced and so you need to pull it out and then you can slot it back into place
do we use a bent case for a straigh bone? HY?
Yes, because the bones like to go back to the same position that they were in before (periosteum tension) and by keeping the cast bent it measn that the fracture is constantly being pushed in the right direction
WHY WOULD WE SUPPLEMENT WITH FIXATION RATHER than just casting?
Severe swelling likely
Need to re-inspect wound (e.g. open fractures)
Multiple injuries
Segmental limb injuries
Fracture very unstable
Approaching skeletal maturity
Why do growth plates get injured?
Weaker than ligaments.
Where can er get main evulsions? how do we classify?
ACL And tibial tuberosity.
Avulsion of ACL
I Undisplaced
II Hinged
III Displaced
I/II Long leg cast
II/III ORIF
How do growth paltes fuse?
central -> medial -> lateral
What is a tillaux(?) fractuure)
Because the ligaments are stronger than the bones, it is when the distal fibular comes off and takes some of the lateral maleoulus with it.
Sagging rope sign is a sign of what? What are the consequences and tratment?
Asymetric growth arrest
What are the indication ofor orif?
Adolescents
Comminuted fractures
Injuries involving joint surface
Monteggia & Galeazzi (MUSGRI)
What is nailing it?
Can flexible nail it but need 2 yrs growth remaining.
Minial disruption and allows early rom
NAI are ususally due to what?
neglect
What are the things to look for in toerrms of nai?
stories that don’t match up. unusual injuries, or stories that don’e allign with the mechanism of injury. burns
If we think a fracture may be due to a nai, then what do we performa nd what do the resultss of this imply?
a full body xray survey to look for other injuries that would impky there have been other injuries. Because 50% recurrence(!) and of that 10% fatalities.
Where are places that nai may occur or be more likely in?
Multiple fractures, metaphyseal, humeral shaft, ribs.
Unable to walk yet but have broke long bones
Key features of osteomyelitis?
Insidious onset, pain. May be systemically unwell.
Can require surgery
Osteomyelitis treatment?
Antibiotics!! Depending on severity, usually 2 weeks IV and then 4 weeks oral but can be longer IV if a worse infection is present
